title: The effect of a hospital-wide urine culture screening intervention on the incidence of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella species.
abstract: OBJECTIVE
  Optimal strategies for limiting the transmission of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella spp (ESBL-EK) in the hospital setting remain unclear. The objective of this study was to evaluate the impact of a urine culture screening strategy on the incidence of ESBL-EK.
  
  
  METHODS
  Prospective quasi-experimental study.
  
  
  METHODS
  Two intervention hospitals and one control hospital within a university health system from 2005 to 2009.
  
  
  METHODS
  All clinical urine cultures with E. coli or Klebsiella spp were screened for ESBL-EK. Patients determined to be colonized or infected with ESBL-EK were placed in a private room with contact precautions. The primary outcome of interest was nosocomial ESBL-EK incidence in nonurinary clinical cultures (cases occurring more than 48 hours after admission). Changes in monthly ESBL-EK incidence rates were evaluated with mixed-effects Poisson regression models, with adjustment for institution-level characteristics (eg, total admissions).
  
  
  RESULTS
  The overall incidence of ESBL-EK increased from 1.42/10,000 patient-days to 2.16/10,000 patient-days during the study period. The incidence of community-acquired ESBL-EK increased nearly 3-fold, from 0.33/10,000 patient-days to 0.92/10,000 patient-days (P < .001). On multivariable analysis, the intervention was not significantly associated with a reduction in nosocomial ESBL-EK incidence (incidence rate ratio, 1.38 [95% confidence interval, 0.83-2.31]; P - .21).
  
  
  CONCLUSIONS
  Universal screening of clinical urine cultures for ESBL-EK did not result in a reduction in nosocomial ESBL-EK incidence rates, most likely because of increases in importation of ESBL-EK cases from the community. Further studies are needed on elucidating optimal infection control interventions to limit spread of ESBL-producing organisms in the hospital setting.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Han
authors.forename: Warren B
authors.initials: WB
authors.lastname: Bilker
authors.forename: Irving
authors.initials: I
authors.lastname: Nachamkin
authors.forename: Theoklis E
authors.initials: TE
authors.lastname: Zaoutis
authors.forename: Susan E
authors.initials: SE
authors.lastname: Coffin
authors.forename: Darren R
authors.initials: DR
authors.lastname: Linkin
authors.forename: Baofeng
authors.initials: B
authors.lastname: Hu
authors.forename: Pam
authors.initials: P
authors.lastname: Tolomeo
authors.forename: Neil O
authors.initials: NO
authors.lastname: Fishman
authors.forename: Ebbing
authors.initials: E
authors.lastname: Lautenbach
mesh_terms: D001437:Bacteriuria / Q000175:diagnosis* / Q000382:microbiology*; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D004926:Escherichia coli / Q000302:isolation & purification* / Q000378:metabolism; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D017053:Infection Control; D007709:Klebsiella / Q000302:isolation & purification* / Q000378:metabolism; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D008403:Mass Screening; D014556:Urine / Q000382:microbiology; D001618:beta-Lactamases / Q000096:biosynthesis
chemical_list: D001618:beta-Lactamases